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Experience within Quality Analytics, HEDIS or Medicare Star Proficiency in any of the following analytics tools: SQL, SAS, Alteryx, R, Python, Tableau, Power BI, CognosKnowledge, Skills and AbilitiesStrong ETL knowledge in a data warehouse ecosystem.
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Provide business process, system support and data quality governance through data coordination and integration to ensure efficient processes and consistent data flows to business and stakeholders.
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This is an ideal opportunity for a highly motivated individual with proven experience in leading and managing testing teams within an enterprise environment, deep understanding of Agile methodologies and experience working as a Product Owner, strong technical skills in test automation, CI/CD, and data quality assessment, excellent communication, interpersonal, and influencing skills, and a passion for quality and a commitment to continuous improvement.
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The incumbent will also manage and develop a team of testers, leveraging their strong technical skills in test automation, CI/CD, and data quality assessment. Description : JOB SUMMARYHighmark Health's Enterprise Data Office (EDO) is seeking a passionate and experienced Testing and Quality Manager to champion a culture of quality and continuous improvement.
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Provide leadership for data analysis, including requirement solicitation, collaboration with engineering and quality teams, testing of core data platforms, and delivering solutions to solve business problems.
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High Speed Roll-feed and cut-sheet printing, High-speed Mail Inserter, SendPro Meter, US Mail and Vendor Package Shipping, Mail Sort Preparation, Quality Control and other peripheral duties associated with a Print to Mail facility.
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This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues.
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Develop and implement data collection systems and other strategies that optimize statistical efficiency and data quality. Ensure the correct first time /quality review processes are utilized and that changes maintain data integrity control processes.
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Directs end-to-end customer implementation operations with accountability for customer satisfaction, financial performance, proactive risk identification, issue resolution, process excellence and quality control.
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Develop, implement and execute the Provider STARs quality strategy, support/develop technology and data strategies to support STARs performance, and provider incentive programs in partnership with senior leadership for the Medicare Advantage Quality Consultants.
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Meets all production and quality standards, ensuring timeliness and accuracy of all work given by support staff/management. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
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As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Works collaboratively with multiple stakeholders, vendors and various cross-functional teams, locations and departments to improve Stars and/or Quality Rating outcomes for Medicare Advantage across footprint.
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This job is responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims. Receives and processes claims to include entering/verifying claims data; determines if claim information is complete and correct.
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Implement quality strategic initiatives with development of action plans that include clarifying the goals/aims and metrics, collaborating with team members to identify ideas/solutions, applying change methodologies, coordinating activities designed to reinforce and embed best-practice changes and next steps to create continuous improvement.
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data quality jobs Company: Highmark Health
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